Operative neurosurgery (Hagerstown, Md.)最新文献

{"title":"Lateral Orbitotomy for Trigeminal Schwannomas: Surgical Technique, Outcomes, and Limitations.","authors":"Maria Karampouga, Bhuvic Patel, I-Sorn Phoominaonin, S Tonya Stefko, Garret Choby, Eric W Wang, Carl H Snyderman, Georgios A Zenonos, Paul A Gardner","doi":"10.1227/ons.0000000000001883","DOIUrl":"10.1227/ons.0000000000001883","url":null,"abstract":"<p><strong>Background and objective: </strong>Trigeminal schwannomas (TSs) are rare, mostly benign tumors that exhibit an indolent clinical course. The lateral orbitotomy approach (LOA), with or without endoscopic assistance, has emerged as a novel skull base route, particularly for accessing lesions confined to the middle cranial fossa. Herein, we elucidate the advantages and limitations of the LOA for the treatment of TSs.</p><p><strong>Methods: </strong>All TS cases that underwent LOA through a lateral canthus incision during the past decade in our department were retrospectively reviewed. The operative technique was detailed, and clinical outcomes were analyzed.</p><p><strong>Results: </strong>Eight patients (4 females) with an average age of 37 years underwent LOA for TSs. The mean maximum tumor diameter was 2.7 cm (range: 1.8-3.7 cm). Seven were primary and one was recurrent, the latter in a patient with neurofibromatosis type 2. All tumors were predominantly in the middle cranial fossa, with 4 having either a small or medium posterior fossa component (6: Samii Type A; 2: Type C). Presenting symptoms included trigeminal neuralgia (n = 6), facial hypoesthesia (n = 6), headache (n = 5), and double vision (n = 3). All patients underwent gross (n = 6) or near-total (n = 2) resection. Neuralgia, while not exacerbated, reappeared in 4 patients after surgery and was ameliorated with medication. Two patients sustained new trigeminal hypoesthesia, and preoperative abducens palsy either improved or resolved in all 3 cases. No orbital complications, cerebrospinal fluid leak, or mortalities occurred. Two lesions had minor recurrence during a mean follow-up of 42.9 months. The first underwent radiosurgery 6 years postoperatively and the second is under close surveillance.</p><p><strong>Conclusion: </strong>Minimally invasive LOA stands as a plausible and aesthetically favorable surgical corridor for addressing TSs of the middle cranial fossa, even with extension into the posterior fossa. However, additional study is required as the approach may be limited for tumors with significant posterior or infratemporal fossa involvement.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":"819-827"},"PeriodicalIF":1.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic Endonasal Resection of Diaphragma Sellae Meningioma: 2-Dimensional Operative Video.","authors":"Carter M Suryadevara, James Ryoo, Emma Bacus, Seth Lieberman, Donato Pacione","doi":"10.1227/ons.0000000000001993","DOIUrl":"10.1227/ons.0000000000001993","url":null,"abstract":"","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":"1002-1003"},"PeriodicalIF":1.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147518309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary: Surgical Management of Optic Pathway-Hypothalamic Gliomas: Institutional Experience and Systematic Review.","authors":"Sapir Lev, Evan Keister, John Boockvar","doi":"10.1227/ons.0000000000002126","DOIUrl":"10.1227/ons.0000000000002126","url":null,"abstract":"","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":"876-877"},"PeriodicalIF":1.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148355517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of High Jugular Bulb in Retrosigmoid Surgery for Vestibular Schwannoma: Analysis of 590 Consecutive Cases.","authors":"Kyosuke Matsunaga, Ken Matsushima, Norio Ichimasu, Nobuyuki Nakajima, Takao Hashimoto, Michihiro Kohno","doi":"10.1227/ons.0000000000001901","DOIUrl":"10.1227/ons.0000000000001901","url":null,"abstract":"<p><strong>Background and objectives: </strong>High jugular bulb (HJB) is an obstacle when performing retrosigmoid intradural temporal drilling for resection of the meatal part of vestibular schwannomas. Some studies reported the technical nuance of the HJB management; however, the indications, impact on surgical outcomes, and long-term outcomes of this challenging management have not been fully analyzed. This study aimed to investigate the clinical and imaging characteristics of patients requiring the intraoperative HJB management, its impact on surgical outcomes, and long-term postoperative follow-up results.</p><p><strong>Methods: </strong>After excluding patients with neurofibromatosis type 2 and those undergoing reoperation, 590 consecutive patients undergoing surgery for vestibular schwannoma were retrospectively investigated. Patients with HJB who required the intraoperative HJB management were compared with those with HJB who did not require the management and with a control group of patients without HJB.</p><p><strong>Results: </strong>Of the 590 patients with vestibular schwannoma, 123 (21%) had HJB, and 23 (3.9%) required the HJB management. In patients requiring the HJB management, the jugular bulb tended to be positioned higher than the lateral semicircular canal and midline of internal auditory meatus. The jugular bulb apex tended to be closer to the surface of the petrous bone in patients requiring the HJB management, and the cutoff distance was 3.3 mm. There were no statistically significant differences in tumor removal rates or retreatment rates, and the sigmoid-jugular venous system remained patent in all 3 groups.</p><p><strong>Conclusion: </strong>The HJB management should be considered when the HJB apex is located at a high position, and the distance between the HJB apex and the surface of the petrous bone is close. Our study demonstrated that the HJB management can be performed safely during drilling of the internal auditory meatus, achieving effective tumor resection without causing venous complications.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":"889-897"},"PeriodicalIF":1.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel Surrogate Indicators of Intracranial Meningioma Consistency and Outcomes After Resection.","authors":"Yash Akkara, Joshua J Hon, Yesh Meadipudi, Alisha Mahmud, Maaira Khan, Ramesh Nair, Joe M Das","doi":"10.1227/ons.0000000000001902","DOIUrl":"10.1227/ons.0000000000001902","url":null,"abstract":"<p><strong>Background and objectives: </strong>Tumor consistency affects resection and outcomes in meningioma surgery. This study aimed to identify predictors of tumor consistency using the Zada grading scale and assess their association with surgical outcomes and prognosis.</p><p><strong>Methods: </strong>We retrospectively reviewed patients aged 18 years and older who underwent intracranial meningioma resection from 2014 to 2024, with ≥1 year of follow-up. Tumors were graded into 5 consistency types per Zada's criteria. Data on demographics, imaging (T2-weighted MRI), histology, and surgical outcomes were collected. Signal intensity ratios between tumor and cortex were calculated. Statistical analyses included analysis of variance, linear regression, receiver operating characteristic analysis, and Cox regression for progression-free survival (PFS).</p><p><strong>Results: </strong>Five hundred and fifty-four patients (67.7% female; mean age 58.1) were included. Firmer tumors were associated with longer operative times (492 vs 382.3 minutes for type 4 vs type 2, P < .0001), higher subtotal resection rates (58.6% vs 15%, P < .0001), and increased psammoma body prevalence (17.2% vs 3%, P < .0001). Adherence to surrounding structures correlated with firmness (β = 0.2953, P = .0046). Softer tumors showed higher SI ratios (1.2 vs 0.95, P = .0027), with an area under the curve value of 0.6888. SI thresholds <0.6533 and >1.547 predicted firm and soft tumors with 95% sensitivity respectively. Type 2 tumors had the lowest complication rates (1.56%), whereas type 5 had the highest reoperation rates (33.3%). Firmer tumors were linked to worse PFS ( P = .0247), primarily due to lower resection extent (β = -0.8752, P = .0007).</p><p><strong>Conclusion: </strong>Higher meningioma consistency is linked to surgical difficulty and poorer PFS. Psammoma bodies, tissue adherence, and SI ratios are promising surrogate markers to guide surgical planning.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":"898-905"},"PeriodicalIF":1.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Skull Base Virtual Reality Surgical Simulator Integrating Multilayered 3D Photorealistic Anatomic Models With 3D Imaging and Segmentations: Transpetrosal Approaches.","authors":"Markus Krogager, Martin Trandzhiev, Kåre Fugleholm, Lars Poulsgaard, Jens Lehmberg, Tiit Mathiesen, Thomas Tursø, Toma Spiriev","doi":"10.1227/ons.0000000000001881","DOIUrl":"10.1227/ons.0000000000001881","url":null,"abstract":"<p><strong>Background and objectives: </strong>Lesions within the petrous bone pose significant surgical challenges and necessitate a detailed 3-dimensional (3D) understanding of the skull base anatomy. Microsurgical dissections are gold standard to acquire such knowledge in combination with patient-specific anatomy derived from diagnostic imaging. Therefore, we developed a virtual reality (VR)-based surgical simulator that fuses and stacks stepwise, photorealistic 3D models of anatomic dissections and 3D angiographies. We sought to demonstrate how VR-based simulation can improve 3D understanding of the skull base anatomy and the surgical anatomy in tumor resections, using transpetrosal approaches as proof-of-concept, with simulated tumor renderings according to the Fisch classification.</p><p><strong>Methods: </strong>One body donor head, ethanol-fixed and arterially injected with a red latex-contrast medium mixture, underwent rotational angiography and stepwise microsurgical dissection following trans- (posterior and combined) petrosal approaches. 3D data consisted of Digital Imaging and Communications in Medicine-based 3D angiographic renderings and photogrammetric 3D models showing each step of the approaches. The 3D models were automatically stacked using a 3D modeling software. The resulting 3D data were imported into a VR-environment. Tumor simulations were placed within the virtual 3D space to improve 3D depth understanding of the petrous anatomy during stepwise surgery.</p><p><strong>Results: </strong>Twenty 3D models created by photogrammetry were automatically stacked in VR to simulate transpetrosal and jugular foramen approaches with parallel 3D angiographic data. This allowed for a stepwise visualization of the surgical stages correlated to angiographic anatomy in an immersive environment. Incorporated tumor simulations were useful to mimic pathological anatomy from tumor propagation.</p><p><strong>Conclusion: </strong>Automatic alignment of 3D models created by photogrammetry and 3D renderings of diagnostic imaging in a VR environment illustrates the surgical steps of complex transpetrosal approaches. The proposed algorithm to create a surgical simulator is not technically demanding, features a semiautomated workflow, and can be used to present complex surgical approaches that require 3D understanding.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":"949-957"},"PeriodicalIF":1.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145902203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscope Assisted Temporal Key Hole Cortico-Amygdalo-Hippocampectomy for Mesial Temporal Sclerosis: 2-Dimensional Operative Video.","authors":"Lokesh Vellore Dasarathan, Prakash Nair, George Chandy Vilanilam, Sagar Ballal, Arwin Das Prabhu, Gowtham Matham, Easwer Hariharan Venkat, Krishnakumar Kesavapisharady","doi":"10.1227/ons.0000000000001968","DOIUrl":"10.1227/ons.0000000000001968","url":null,"abstract":"","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":"992-993"},"PeriodicalIF":1.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147367650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary: Biomechanical Comparison of Transforaminal Interbody Fusion Implants: Static Versus Expandable Cages and Unilateral Versus Bilateral Cages.","authors":"Advith Sarikonda, Harsh Jain, Scott L Zuckerman","doi":"10.1227/ons.0000000000001917","DOIUrl":"10.1227/ons.0000000000001917","url":null,"abstract":"","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":"838-839"},"PeriodicalIF":1.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pure Endoscopic Contralateral Transfalcine Transparieto-Occipital Fissure Approach to the Atrium of the Lateral Ventricle: Anatomic Study.","authors":"Alberto Morello, Francesco Corrivetti, Augusto Leone, Alessandro Pesaresi, Francesco Carbone, Diego Garbossa, Fabio Cofano, Matteo de Notaris","doi":"10.1227/ons.0000000000001928","DOIUrl":"10.1227/ons.0000000000001928","url":null,"abstract":"<p><strong>Background and objectives: </strong>The atrium is one of the most complex regions to approach in the brain because of its deep location and the complexity of the surrounding white matter fiber anatomy. The ipsilateral posterior interhemispheric transprecuneus approach was first described, and subsequently, the contralateral posterior interhemispheric transprecuneus approach gained popularity. Each surgical route presents some disadvantages such as the difficulty of exposing the lateral portion of the lesion, the presence of bridging veins, brain retraction, and the risk of memory impairment. We present an alternative approach to lesions of the atrium using a natural pathway through the parieto-occipital fissure. The aim of this anatomic study is to evaluate the surgical feasibility of the contralateral transfalcine transparieto-occipital fissure approach (CTTFa) and the usefulness of the endoscope as the sole visualization source.</p><p><strong>Methods: </strong>Four formalin-fixed cadaver heads were used for this study and investigated to perform 8 surgical CTTFa procedures. Surgical measurements were obtained, evaluating skin incision, craniotomy area, working area and distance from the craniotomy to the splenium, the parieto-occipital fissure, and the atrium. Moreover, 2 human cerebral hemispheres treated using the Klingler technique were used to investigate the relative white matter anatomy.</p><p><strong>Results: </strong>The craniotomy area measurements averaged 8.2, 4.2, and 3.1 cm 2 for the ipsilateral posterior interhemispheric transprecuneus approach, CTTFa without endoscopy, and CTTFa with the use of an endoscope, respectively. In addition, the endoscopic CTTFa showed an optimal working angle and distance from craniotomy to parieto-occipital fissure, splenium, and atrium.</p><p><strong>Conclusion: </strong>The pure endoscopic CTTFa allows adequate visualization of the atrium while minimizing brain retraction, avoiding damage to white matter tracts, and reducing both the size of the craniotomy and the skin incision. This is achieved without exposing the superior sagittal sinus or damaging the precuneus area.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":"941-948"},"PeriodicalIF":1.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microsurgical Resection of an Atrium Meningioma via the Posterior Interhemispheric Transparieto-Occipital Fissure Approach: 2-Dimensional Operative Video.","authors":"Yücel Doğruel, Semih Fidan, Abuzer Güngör, Uğur Türe","doi":"10.1227/ons.0000000000001992","DOIUrl":"10.1227/ons.0000000000001992","url":null,"abstract":"","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":"1000-1001"},"PeriodicalIF":1.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147477829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}